Just was reading an interesting article on police and mental health.  Not the mental health of police, although that would be a very important issue to know more about.  Can you imagine the stresses of that occupation?  But about how police respond to individuals who are exhibiting mental health problems, or individuals with mental disorders who are in distress or acting in such as way as to be causing distress to others.  So here is the piece: http://www.guardian.co.uk/commentisfree/cifamerica/2010/jul/14/police-mental-health-training. As you can see the title is: US Police need proper training in mental health.  And the sub-title is: “People suffering mental health crises are too often subjected to brutality by poorly trained and frightened police officers”  According to the writer (in a UK paper by the way): “Every day in various American communities, people enter mental health crises and their friends and family members pick up the phone to call for help. Often, the first responders on the scene are police officers, and the resulting interaction does not go well. Poorly trained and frightened police officers may resort to excessive force, and sometimes this ends in death for a person who is guilty only of being in urgent need of psychiatric care.”

Although the piece is long on hyperbole and heart wrenching descriptions of police attacking individuals suffering from mental disorders, and short on any substantive data and overall balanced reporting regarding what police forces are actually doing, the writer does bring attention to an important issue.  Certainly police officers should have more training in dealing with the unique needs of people who have mental illnesses and who are behaving in a way that may put them or others at risk of harm.  Certainly we need more and better community based mental health care services.  These needs are real and we have to get working on doing more.

But it is also important to recognize that much has been done in the last decade or so.  Here in Halifax, there is a mobile crisis service that I am proud to have been part of its launch.  It pairs police officers with mental health professionals.  It goes to where people need them and it works – not perfectly mind you, but it works.  One of my colleagues, Dr. Bianca Horner and members of the Department of Psychiatry and the Mental Health Program have developed a national training program for the RCMP, called “Recognition of Emotionally Disturbed Persons” regarding this matter.  Other police forces in Canada are now beginning to address this issue.  I have had the opportunity to be part of the Minister’s task force on TASER in Nova Scotia and the privilege to chair the sub-task force on excited delirium.  As a result of these reports there have been substantive movements towards improving all aspects of first responder approaches to individuals with mental disorders.

While these are a good beginning we certainly have to do more.  It is not appropriate nor is it fair nor is it right that our prisons have become holding bins for people who require mental health care.  The federal government has decided to build more prisons.  I for one would like to see them invest more in mental health care instead.  Don’t you think it’s preferable to treat someone who has a mental disorder in such as way as to assist and support their recovery instead of throwing them in jail?  I do.

–Stan

There was a tragic story in the Halifax newspaper, the Chronicle Herald this week: http://thechronicleherald.ca/Front/1185324.html. The story was both new and unfortunately very old at the same time. The gist of the story was that a young man who had killed a woman a number of months ago was found not criminally responsible because, as the story states: “the teen was psychotic when he killed a woman in February”.

Although there are few details of what happened in the paper, it seems as if the young man had been experiencing psychotic symptoms for some time prior to the event. Apparently, “his family had been trying to get him psychiatric help”.

What a shame. How tragic. How sad. How ironic, that Nova Scotia has one of the nation’s best first onset psychosis programs. What happened? What is the back story?

The Province of Nova Scotia spends about 3.5% of its annually recurring health care budget on mental health, and a fraction of that on child and youth mental health services. This is in spite of the knowledge that about 3/4th of all mental disorders arise prior to the age of 25 years and increasing realization that early intervention and effective treatment may prevent substantial long and short term negative outcomes and yes, maybe in this case would have prevented such a tragic outcome.

I for one am getting sick and tired of reading these stories and writing these blogs. I have decided to run for federal office in Halifax in part to make mental health a national health agenda item. This tragic case should not have happened. Why is it taking so long to do so little that can help so many so much?

–Stan

Mental disorders collectively constitute the largest burden of disease in young people. They have substantial negative short- and long-term outcomes across many domains, yet early identification and effective intervention can improve outcomes and can often lead to recovery.

Unfortunately, many young people do not receive the mental health care they require and may consequently enter the justice system. Studies of incarcerated youths show that up to 70% of them have mental disorders. Many of these youth receive primarily custodial care.

A variety of social, legal and medical interventions can and should be implemented to ensure that young people suffering from mental disorders do not inappropriately enter the justice system due to lack of access to health care and other services.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illness(es), a substance abuse problem, and/or a learning disability. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons. Supreme Court Justice Beverly McLaughlin in a statement in on March 8^th, 2007 stated that “Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both.”

Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a “faint hope” that arrest will lead to treatment which for a variety of different reasons is not otherwise available.

Last week Hon. Judge Michael McKee produced a report calling for 80 recommendations to patch up the cracks in New Brunswick’s mental health system.

“The stigmatization of the mentally ill, the criminalization of the mentally ill in our court system and the silos of government not working together, that’s something that’s gone on for essentially decades and it has to be fixed,” Murphy said.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

Download: Together into the Future: A transformed mental health system for New Brunswick

~ Dr. Stan Kutcher & Ainslie McDougall